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Step 3 Sample Questions November 2020

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Step 3 Sample Questions November 2020 SAMPLE TEST QUESTIONS Step 3 A Joint Program of the Federation of State Medical Boards of the United States, Inc., and the National Board of Medical Examiners® This booklet was updated November 2020. Copyright © 2020 by the Federation of State Medical Boards of the United States, Inc. (FSMB), and National Board of Medical Examiners® (NBME®). All rights reserved. Printed in the United States of America. The United States Medical Licensing Examination® (USMLE®) is a joint program of the FSMB and NBME. CONTENTS USMLE Step 3 Multiple Choice Test Question Formats .......................................... 2 Introduction to USMLE Step 3 Sample Test Questions........................................... 6 USMLE Step 3 Normal Laboratory Values ............................................................... 7 Answer Form for USMLE Step 3 Sample Questions .............................................. 10 USMLE Step 3 Sample Test Questions .................................................................. 11 Answer Key for USMLE Step 3 Sample Questions ................................................ 79 USMLE STEP 3 MULTIPLE-CHOICE TEST QUESTION FORMATS The following are strategies for answering one-best-answer questions (eg, Single Items, Multiple Item Sets, and Sequential Item Sets): ● Read each patient vignette and question carefully. It is important to understand what is being asked. ● Try to generate an answer and then look for it in the option list. ● Alternatively, read each option carefully, eliminating those that are clearly incorrect. Of the remaining options, select the one that is most correct. ● If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong answers. Patient Scenario Formats Patient scenarios for any Single Item or Sequential Item Set may be provided in either Vignette (paragraph) format, or in Chart/Tabular format. Questions written in Chart/Tabular format will contain relevant patient information in list form, organized in clearly marked sections for ease of review. Familiar medical abbreviations may be used within Chart/Tabular format questions. Single-Item Questions A single patient-centered scenario is associated with one question followed by four or more response options. The response options for all questions are lettered (ie, A, B, C, D, E). You are required to select the best answer to the question. Other options may be partially correct, but there is only ONE BEST answer. This is the traditional, most frequently used multiple-choice question format on the examination. Example Question 1 1. A 30-year-old man comes to the emergency department because of an acute episode of renal colic. Medical history is remarkable for episodes of painful urination and passing of what he calls "gravel in my urine." Urinalysis demonstrates microscopic hematuria with some crystalluria and no casts. Supine x-ray of the abdomen shows no abnormalities. A 4-mm renal calculus is detected in the distal right ureter on ultrasonography. There is no evidence of dilation of the collecting system. The patient's pain is responsive to narcotic medication. In addition to administering intravenous fluids, which of the following is the most appropriate next step? A. Acidification of urine by drinking cranberry juice B. Cystoscopic removal of the calculus C. Cystoscopic ureteral lavage D. Shock wave lithotripsy E. Straining of the urine (Answer: E) 2 Multiple Item Sets A single patient-centered scenario may be associated with two or three consecutive questions about the information presented. Each question within these sets is associated with the patient scenario and is independent of the other question(s) in the set. The questions within this type of format are designed to be answered in any order. You are required to select the ONE BEST answer to each question. Example Questions 2 to 3 A 52-year-old man returns to the office for reevaluation of an ulcer on his right great toe. The patient has a 15-year history of diabetes mellitus and takes glipizide and rosiglitazone. He first noticed the ulcer 2 months ago. One month ago, a 14-day course of oral amoxicillin-clavulanate therapy was prescribed. He has smoked one pack of cigarettes daily for the past 37 years. He is 178 cm (5 ft 10 in) tall and weighs 102 kg (225 lb); BMI is 32 kg/m2. Today, vital signs are temperature 38.8°C (101.8°F), pulse 96/min, respirations 12/min, and blood pressure 130/85 mm Hg. Physical examination of the right great toe discloses a 1.5-cm nontender ulcer with a depth of 0.5 cm, a moist base, yellow exudate, and surrounding erythema to the level of the malleoli. Vibration sense and sensation to monofilament examination are absent. Pulses are diminished in both feet. Capillary refill time is 2 seconds in the right great toe. Urinalysis discloses 3+ protein. 2. Which of the following historical factors or physical examination findings is most strongly associated with development of this patient's foot ulcer? A. Diminished pedal pulses B. Neurologic findings C. The patient's weight D. Proteinuria E. Tobacco use (Answer: B) 3. Which of the following is the most appropriate action at this time? A. Begin aggressive debridement in the office B. Begin intravenous antibiotic therapy C. Refer the patient for transmetatarsal amputation D. Schedule the patient for a third-degree skin graft E. Switch the amoxicillin-clavulanate to oral ciprofloxacin (Answer: B) 3 Sequential Item Sets A single patient-centered scenario may be associated with two or three consecutive questions about the information presented. Each question is associated with the initial patient scenario but is testing a different point. You are required to select the ONE BEST answer to each question. Questions are designed to be answered in sequential order. You must click "Proceed to Next Item" to view the next question in the set; once you click on this button, the next question will be displayed, and you will not be able to add or change an answer to the previous question. Example Questions 4 to 5 A 2-year-old girl is brought to the office by her mother for evaluation of fever. You have been the girl's physician since birth. While in the office, the girl stiffens and then has bilateral, symmetrical shaking of her upper and lower extremities; she becomes mildly cyanotic. The episode lasts for approximately 45 seconds, after which she becomes relaxed and appears to fall asleep. Vital signs at this time are temperature 40.0°C (104.0°F), pulse 120/min, and respirations 40/min. On physical examination she has a generally pink complexion and flushed cheeks. She is limp and somnolent and responds with a cry to noxious stimulus. Tympanic membranes are inflamed bilaterally, nose has a scant, clear discharge, and throat is mildly erythematous. Lungs are clear to auscultation except for transmitted upper airway sounds. Heart has rapid rate with a grade 1/6 systolic murmur at the left sternal border. Complete blood count, blood culture, lumbar puncture, and catheterized urine specimen are obtained and sent for stat analysis. Acetaminophen is administered by rectal suppository. Thirty minutes later the patient awakens and is smiling. She is afebrile. Additional history discloses that she was born at term, she had an uneventful neonatal course, she has normal growth and development, and vaccinations are up-to-date. She has never had an episode similar to this. Initial laboratory results are shown: Blood WBC 10,400/mm3 Neutrophils, segmented 25% Neutrophils, bands 5% Lymphocytes 65% Monocytes 5% Cerebrospinal fluid 0 RBC/mm3 Urinalysis Normal Other laboratory studies are pending. 4. In addition to ampicillin for otitis media and acetaminophen, this child also should receive which of the following? A. Oral ethosuximide B. Oral phenobarbital C. Oral phenytoin D. Rectal diazepam E. No additional medications (Answer E) 4 5. Two weeks later the patient is brought to the office for a follow-up visit. Her mother says that she is doing well and she has had no recurrence of her symptoms. Examination of the ears shows resolution of the otitis media. Which of the following is the most important diagnostic step at this time? A. Audiology testing B. Cognitive testing C. CT scan of the head D. EEG E. No additional testing (Answer E) 5 INTRODUCTION TO USMLE STEP 3 SAMPLE TEST QUESTIONS The following pages include 137 sample test questions. Please note that reviewing the sample questions is not a substitute for acquainting yourself with the test software. You should run the Step 3 tutorial and practice test questions that are provided on the USMLE website well before your test date. The sample materials on the USMLE website include additional item formats that do not appear in this booklet (eg, items with associated audio findings). Note that the function of items such as pharmaceutical ads, abstracts, and sequential item sets is unique in an examination interface. You should become familiar with all test question/item formats as they will be used in the actual examination. In addition, the computer-based case simulation (CCS) format you will see on an actual Step 3 examination is not represented in this booklet. You must become familiar with the CCS format by reading information available in the USMLE Content Description and General Information booklet and by practicing with sample CCS cases before you take the Step 3 examination; the information and the practice materials are available on the USMLE Web site (www.usmle.org). These sample questions are illustrative of the types of questions used in the Step 3 examination. Although the questions exemplify content on the examination, they may not reflect the content coverage on individual examinations. Questions are grouped together by the content appropriate for each examination day in the same manner as in the actual computer-administered test blocks. In the actual examination, the questions will be presented one at a time in a format designed for easy on-screen reading, including use of a panel for the table of normal laboratory values (included here on pages 7–9) and some pictorials.
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